Insurance World

Health Maintenance Organizations, also known as HMOs, and Preferred Provider Organizations, also known as PPOs, are just two types of health insurance plans that belong to a larger spectrum of health insurance plans called Managed Care Insurance.

The characteristic that all health insurance plans categorized as managed care insurance have in common is that they provide policy holders with a list of doctors and other health care providers that they would prefer the policy holders to visit when in need of medical attention. The doctors and other health care providers are contracted to work with the health care plan’s network, which means the policy holder will be able to pay less money to visit them that he or she would pay to visit a doctor not on the list, or “out-of-network.”

So, what’s the difference between HMOs and PPOs?

Health Maintenance Organizations, or HMOs, require their policy holders to pay a monthly insurance bill in order to see a doctor or health care provider, regardless of whether or not the policy holder actually seeks medical attention during that month. This may not sound like a very good deal, but HMOs do tend to provide a vast array of medical services for their policy holders under the HMO health insurance plan.

Preferred Provider Organizations, or PPOs, include a network of doctors and other health care providers that cover only a specific group of policy holders, such as the employees of a company. Policy holders pay a co-payment at the time of service, and the rest of the bill is either sent to the insurance company, or paid by the policy holder who is then reimbursed by the insurance company.

Being a policy holder of an HMO or PPO doesn’t always mean you have to see a doctor or other health care provider included in the network. Sometimes HMOs and PPOs allow you to seek out-of-network medical attention at an increased price.

“Those magnificent men in their flying machines…” Ever since the Wright brothers pioneered our ascent into the skies we have strived to fly higher, faster, further with aeronautical advancements surpassing one another at an ever-increasing rate.

Taking to the skies is, of course, much more than the romantic notions upheld in quaint versions of “Up, up and Away” or “Come fly me, let’s fly, let’s fly away…” It is, for most aircraft owners, a significant part of their livelihood and not to be contemplated without the proper insurance.

Aviation insurance is different from other forms of insurance in that it is very subjective. Due to the vast array of aircraft types, uses and pilot experience, policies should always be specifically tailored to suit the unique requirements of each individual applicant. For this reason it is recommended that a broker, specialising in aviation insurance be engaged to arrange cover.

When applying for aviation insurance, several matters will be taken into account including:

• Sum insured: Aviation policies are divided into

i. Hull: The loss of or damage to the aircraft.

ii. Liability: Loss of or damage to property belonging to others and/or bodily injury to others as a result of the insured’s negligence

Aviation insurance is based on “agreed value”. This means that, in the event of a total loss in respect of the hull, the amount agreed to in the policy is what will be paid upon acceptance of the claim.

It is vital that the aircraft be insured for its true value as major difficulties can arise for the owner if the amount is under or overinsured. For example, if an aircraft is grossly underinsured, the agreed value will not be enough to enable the owner to replace it.

In the case of overinsurance, the insurer may decide to approve a lengthy repair process, costing more than the market value but less than the agreed value. This will result in major delays to plans of getting “back in the air”.

Liability is a different issue with settlements determined in most large cases by the courts.

• Type of aircraft: Generally, helicopters cost more to insure than fixed wing aircraft. Here in Australia, this is partly due to the manners in which they are employed, for example, mustering livestock and heavy industrial use.

Helicopter accidents are also more likely to result in a total loss of the aircraft than fixed wing accidents. What would seem a relatively minor “heavy landing” in a fixed wing aircraft would most likely write-off a helicopter.

The best way to ensure the lowest price possible is quoted for the aircraft, fixed wing or rotary, is to be clear with the insurer exactly what it will be used for. For business owners, it may be worthwhile considering whether diversifying from the central business function is worthwhile if diversification results in more hazardous usage of the aircraft.

• Pilot Experience: Pilot experience and qualifications are the most important aspects of determining the amount of the premium and level of coverage. In some cases, cover may not be extended if the pilot has not enough hours in the air logged.

If any persons other than the owner are to be flying the aircraft it is the owner’s responsibility to ensure all details regarding additional pilots be accurate and up to date. Inaccurate information can lead to a claim being rejected. There are basically three types of pilots able to fly the insured aircraft:

i. Owner: Self explanatory

ii. Open Pilot Warranty: The Open Pilot Warranty (OPW) is the minimum standard of requirements that must be met in order for a pilot to fly the insured aircraft. Although names of OPW pilots do not have to be notified to the insurer, it is crucial to ensure that all OPW pilots meet the requirements for the insured aircraft. Remember that the OPW for one type of aircraft may not be satisfactory for another.

iii. Named Pilots: These are persons you will be permitting to fly the aircraft but who do not meet the OPW standards. Using Named Pilots will generally mean a higher premium.

It is useful to consider the insurer’s position here. An aircraft is a high level of risk to the insurer. In order to underwrite that risk it must be worthwhile. Since most aircraft accidents are statistically due to pilot error, more premium must be charged for less experienced pilots to justify the risk.

Once cover is granted, renewal after one year is not always automatic.

As the renewal date approaches, cover is re-evaluated along with the premium. This can have a positive outcome as pilot experience and any additional training undertaken will be considered when calculating the new premium.

Overall, the main issue to be understood is that all information given regarding the aircraft to be insured and its pilot(s) is to be as accurate and up to date as possible. Whether or not this leads to a premium one may deem “cheap” is irrelevant. What is relevant is that the premium will be a true reflection of the risk.

And that is as insurance should be.